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Health Insurance (Expert Forum)
worried about new HMO denying benefits or canceling plan
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worried about new HMO denying benefits or canceling plan
by hwanhwan, Jun 13, 2007 08:57PM
I am a maryland resident. i recently had a short-term plan, during the course of which i was diagnosed with a tumor (benign) in my ear. i had it removed, and it was covered. i need a followup surgery in august or so. my short-term policy ends on july 1. i have since joined an individual HMO plan with CareFirst in maryland. of course, i disclosed the ear tumor on my application. however, one thing concerns me and i think might be a basis for CareFirst trying to deny benefits based on my failure to disclose information.
i took a look at my application yesterday to make sure i had disclosed everything correctly and i accidentally noted the condition as "fully" recovered. but i also put the dates of treatment as april 2007-july 1, 2007. my coverage started june 1, 2007. additionally, CareFirst asked me to submit a medical report form to my doctor to fill out, which he did. i have learned that nothing was in my records regarding a second surgery, and essentially that the doctor must have only determined that i needed the second surgery when i went in last week (june 6). given the fact that i noted that i needed treatment until july, which is after my coverage began, and given the fact that my records at the time the insurance company requested them did not note that i needed a second operation, does anyone have any thoughts on whether they might try to claim that i did not disclose my condition? i think they are on really shaky ground in doing that, but i wanted to see what others might think.
i am not worried about them excluding a preexisting condition, as HMOs in maryland are not permitted to do so, from my understanding. thanks.
i took a look at my application yesterday to make sure i had disclosed everything correctly and i accidentally noted the condition as "fully" recovered. but i also put the dates of treatment as april 2007-july 1, 2007. my coverage started june 1, 2007. additionally, CareFirst asked me to submit a medical report form to my doctor to fill out, which he did. i have learned that nothing was in my records regarding a second surgery, and essentially that the doctor must have only determined that i needed the second surgery when i went in last week (june 6). given the fact that i noted that i needed treatment until july, which is after my coverage began, and given the fact that my records at the time the insurance company requested them did not note that i needed a second operation, does anyone have any thoughts on whether they might try to claim that i did not disclose my condition? i think they are on really shaky ground in doing that, but i wanted to see what others might think.
i am not worried about them excluding a preexisting condition, as HMOs in maryland are not permitted to do so, from my understanding. thanks.
